Alcoholic Liver Disease – Part 2

• Alcoholic liver disease is a condition which contributes to the hepatic manifestations of over consumption of alcohol.
• Alcohol is the basic reason for the rise of liver disease especially in Western countries.
• Although steatosis (fatty liver) will build up in a person who consumes a large level of alcohol based drinks spanning a long time, this is transient and reversible.

Risk factors for Alcoholic Liver Disease

Alcoholic Hepatitis
• Alcoholic hepatitis is considered as the soreness of hepatocytes.
• Between 10% and 35% of heavy drinkers develop alcoholic hepatitis.
• While development of hepatitis is not proportional towards dose of alcohol, a number of people seem more prone to this reaction than others.
• This is known as alcoholic steato necrosis.
• The inflammation looks like to be predisposed to liver fibrosis.
• Inflammatory cytokines like TNF-alpha, IL6 and IL8 are required for the induction and perpetuation of injury of the liver.
• This is done by inducing apoptosis and necrosis.
• One possible mechanism of the increased activity of TNF-α is the increased intestinal permeability on account of liver disease.
• This facilitates the absorption in the gut-produced endotoxin in the portal circulation.
• The Kupffer cells in the liver then phagocytose endotoxin, stimulating the release of TNF-α.
• TNF-α then triggers apoptotic pathway throughout the activation of caspases, producing cell death.

Cirrhosis
• Cirrhosis is a serious liver disease which is at a later stage. It is marked by:
– Inflammation
– Fibrosis
– Damaged membranes preventing detoxification of chemicals in the body
– Ending in scarring
– Necrosis
• 10% to twenty% of heavy drinkers will develop cirrhosis of the liver.
• Acetaldehyde will lead to alcohol-induced fibrosis which occurs by collagen deposition which is done by hepatic stellate cells.
• Producing oxidants produced by NADPH Oxi- dase or cytochrome P-450 2E1
• The development of acetaldehyde-protein adducts damage the cell membrane.Symptoms include:
– Jaundice
– Liver enlargement
– Pain
– Tenderness
– Morphological changes in damaged liver architecture.

Late complications of cirrhosis or liver failure include:
– Portal hypertension portal vein
– Coagulation disorders
– Ascites
– Hepatic encephalopathy
– The hepatorenal syndrome
• Cirrhosis also can be a consequence of other causes than alcohol abuse, for instance viral hepatitis and heavy contact with toxins other than alcohol.
• The late stages of cirrhosis may look similar medically, in spite of cause.
• This phenomenon is termed the “final common pathway” with the disease.
• Fatty change and alcoholic hepatitis with abstinence might be reversible.
• The later stages of fibrosis and cirrhosis usually are irreversible, but not usually be contained with abstinence for a long time.

Diagnosis of Alcoholic Liver Disease

• There are several tests to assess alcoholic liver damage.
• Besides blood examination, physicians use ultrasound as well as a CT scan to assess liver damage.
• In some instances a liver biopsy is completed.
• This minor procedure is completed under local anesthesia.
• It calls for putting a small needle inside the liver and receiving a slice of tissue.
• The tissue is then sent to the laboratory for being examined within the microscope.